EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Tuesday, May 21, 2019

The epidemiological situation of the Ebola Virus Disease dated May 20, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,847, of which 1,759 are confirmed and 88 are probable. In total, there were 1,223 deaths (1,135 confirmed and 88 probable) and 487 people healed.

• 292 suspected cases under investigation;

• 21 new confirmed cases, including 5 in Beni, 5 in Kalunguta, 4 in Butembo, 4 in Musienene, 2 in Mabalako and 1 in Masereka:

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Butembo and 1 in Musienene;

º 2 deaths at the CTE of Beni;

• 3 new healed CTE patients, 2 in Butembo and 1 in Katwa;

• One health worker in Masereka, vaccinated, is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 104 (5.6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Operations of the response

• On the sidelines of the 72nd World Health Assembly (WHA) in Geneva, the Minister of Health, Dr. Oly Ilunga, the WHO Director General, Dr Tedros Adhanom Ghebreyesus, and the Director of the WHO Regional Office in Africa (AFRO), Dr Matshidiso Moeti, reported on the evolution of the Ebola outbreak and regional preparedness activities at a meeting of AMS Committee A on Tuesday 21 May 2019.

• All stakeholders recognized that the main barrier to ending this epidemic is the security context and violence against the response teams. The Minister of Health recalled that, from the point of view of public health, Ebola virus disease is not a particularly difficult disease to contain, especially since the country currently has a diagnostic, therapeutic medical arsenal and comprehensive preventive for the first time in the history of the virus. He recalled that to break the chain of transmission, it is enough to do a series of important activities around the confirmed cases, dead or alive, in particular the sensitization, the epidemiological investigations, the disinfection of the household, the vaccination and the follow-up of the contacts, and funerals worthy and secure. All these activities are available but teams are sometimes prevented from doing them because of insecurity or mistrust of the population. The Director of WHO emphasized that the Ebola epidemic in the DRC is still ongoing, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic. not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic.

• While welcoming the work of the Congolese Government in containing the Ebola outbreak, the Director of WHO-AFRO presented the progress of regional preparedness in case the Ebola outbreak spreads outside the DRC. To date, no cases of Ebola have been detected in DRC's neighboring countries thanks to the efforts of the Government and partners, who have examined more than 50 million travelers at the various health checkpoints located east of the DRC. country. As part of the regional preparedness plan, the nine countries bordering the DRC now have an emergency plan, 16 Ebola treatment centers have been built in neighboring countries, 270 technical experts have been deployed to support the efforts of border countries.

FIGURES OF THE RESPONSE

121,202 vaccinated persons

• 564 people vaccinated on 20/05/2019.

• Of those vaccinated, 33,118 are high-risk contacts (CHR), 59,281 are contacts of contacts (CC), and 28,803 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,126 in Katwa, 24,788 in Beni, 15,069 in Butembo, 9,208 in Mabalako, 6,021 in Mandima, 4,235 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,972 in Lubero , 1,945 to Masereka, 1,935 to Vuhovi, 1,817 to Kyondo, 1,487 to Bunia, 1,558 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Dr. Michael Ryan, Executive Director of the WHO Health Emergencies Program, has just completed a two-day mission to Butembo, one of the areas affected by the Ebola outbreak in the DRC. It describes a delicate situation, made even more complicated by the activities of armed groups and the resistance of local communities.

Among the main obstacles to the response to the Ebola epidemic in the DRC, Michael Ryan, Executive Director of the WHO Health Emergencies Program, first described an increasingly difficult security environment.

"It's not possible to stop Ebola in such a situation of community-level tensions, political manipulation, and all armed groups. The situation on the ground is not calm enough for public health operations, "he said.

On Saturday, the Ministry of Health reported that the head of the safe burial team had been attacked in Bunia. Another team suffered the same fate in Butembo on Friday.

This difficult environment is forcing teams to start over, as Michael Ryan has seen. "The problem now is reinfection of the areas. We stopped the transmission to Beni, we stopped the transmission to Mangina, Mabalako, but we still have a little transmission, "he notes.

The other challenge is contamination even in the treatment centers. "We must stop, absolutely stop transmission in health facilities, pleaded the executive director of the WHO. This is a disaster, it is a real tragedy to have transmissions in the very places where people go for care."

Since the beginning of the epidemic, 102 health workers have been infected; 34 have died.

Recurring mechanisms

Resistance to the response has made the epidemic more and more deadly. In the sector of Beni-Butembo, more than 200 people succumbed to the virus in a fortnight. According to the latest WHO figures, since the beginning of the epidemic in the DRC, there have been nearly 1,150 deaths for more than 1,700 confirmed and probable cases.

This is not the first time that there has been such resistance to the response. In West Africa, for the Ebola outbreaks between 2013 and 2015, this was also the case. There had been misinformation campaigns, attacks on health centers and even staff.

The American anthropologist Adia Benton worked on these epidemics. "It happened in Liberia and Sierra Leone in areas where there was already mistrust of the people towards the government," she says. Some people really believed that the information that was given about Ebola was false or was part of a conspiracy that targeted them personally."

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Tuesday, May 14, 2019

The epidemiological situation of the Ebola Virus Disease dated May 13, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,720, of which 1,632 are confirmed and 88 are probable. In total, there were 1,136 deaths (1,048 confirmed and 88 probable) and 459 people cured.

• 293 suspected cases under investigation;

• 15 new confirmed cases, including 4 in Beni, 3 in Katwa, 2 in Butembo, 2 in Mandima, 2 in Musienene, 1 in Lubero and 1 in Alimbongo;

º A new health zone affected: Alimbongo. Extensive investigation in progress to identify the health area where the person was contaminated.

• 12 new confirmed deaths, including

º 4 community deaths, 2 in Musienene, 1 in Butembo and 1 in Mandima;

º 8 deaths at CTE, including 3 in Butembo, 3 in Mabalako and 2 in Katwa;

• 3 new healings from the Katwa CTE;

• 1 health worker, vaccinated less than 10 days ago, in Beni is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 102 (5.9% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

WEEKLY SUMMARY OF EPIDEMIOLOGICAL DATA

Week 19 (May 6-12, 2019)

For the week from May 6 to 12, 2019, we recorded:

• 1,936 suspected cases investigated and tested in the laboratory

• 111 new confirmed cases

• 57 deaths of confirmed cases

º Of the 57 deaths, 40 were community deaths, or 70.1%, and 17 occurred in an ETC.

• 22 new probable cases

• 17 new healed people came out of ETCs

Due to the security situation, the response activities in Butembo and neighboring areas were partially suspended between 4 and 9 May 2019. Thus, the figures presented above are underestimated in relation to the reality of the situation. ground.

NEWS

Operations of the response

Nothing to report

Security situation

The triage of Kayna's General Referral Hospital was vandalized by strangers on Tuesday, May 14, 2019 around 2 am The individuals started throwing pebbles on the yard before firing some tarps.

FIGURES OF THE RESPONSE

115,389 people vaccinated

• 836 people vaccinated on 13/05/2019.

• Of those vaccinated, 31,130 are high-risk contacts (CHR), 55,772 are contacts of contacts (CC), and 28,487 are front-line providers (PPL).

• Persons vaccinated by health zone: 31.103 in Katwa, 24.184 in Beni, 14.146 in Butembo, 7.825 in Mabalako, 5.863 in Mandima, 3.678 in Kalunguta, 3.070 in Goma, 2.998 in Komanda, 2.569 in Oicha, 1.980 in Kayna, 1.930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,522 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,237 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Monday, May 13, 2019

The epidemiological situation of the Ebola Virus Disease dated May 12, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,705, of which 1,617 are confirmed and 88 are probable. In total, there were 1,124 deaths (1,036 confirmed and 88 probable) and 456 people healed.

• 251 suspected cases under investigation;

• 25 new confirmed cases, including 10 in Kalunguta, 7 in Mabalako, 3 in Katwa, 2 in Butembo, 1 in Mangurujipa, 1 in Musienene and 1 in Kyondo;

• 7 new confirmed case deaths, including

º 5 community deaths, 2 in Mabalako, 2 in Butembo and 1 in Kalunguta;

º 2 deaths at CTE, including 1 in Butembo and 1 in Mabalako;

• 6 new healings from ETCs, including 5 in Mabalako and 1 in Katwa;

• Two unvaccinated health workers (one in Mabalako and one in Kalunguta) are among the new confirmed cases.

º The cumulative number of confirmed / probable cases among health workers is 101 (5.9% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

Security situation

• One person died during a militia assault on the Ebola Treatment Center in Katwa on Monday, May 13, 2019 around one in the morning. Butembo Mayor Sylvain Mbusa Kanyamanda says he is an assailant who was killed by the defense and security forces. The urban authority reassured that no material damage was recorded.

FIGURES OF THE RESPONSE

114,553 Vaccinated persons

• 486 people vaccinated on 12/05/2019.

• Of those vaccinated, 30,816 are high-risk contacts (CHRs), 55,294 are contacts of contacts (CC), and 28,443 are front-line providers (PPLs).

• Persons vaccinated by health zone: 30,886 in Katwa, 24,064 in Beni, 14,006 in Butembo, 7,730 in Mabalako, 5,803 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,954 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,472 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Sunday, May 12, 2019

The epidemiological situation of the Ebola Virus Disease dated May 11, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,680, of which 1,592 are confirmed and 88 are probable. In total, there were 1,117 deaths (1,029 confirmed and 88 probable) and 450 people healed.

• 268 suspected cases under investigation;

• 18 new confirmed cases, including 5 in Mabalako, 4 in Beni, 2 in Mangurudjipa, 2 in Kalunguta, 1 in Butembo, 1 in Mandima, 1 in Musienene, 1 in Katwa and 1 in Kyondo;

• 5 new deaths of confirmed cases, including

º 4 community deaths, including 1 in Butembo, 1 in Kalunguta, 1 in Kyondo and 1 in Beni;

• 1 death at Katwa CTE;

• 4 new healed CTE survivors, including 3 in Katwa and 1 in Butembo;

• One of Manugurujipa's unvaccinated health workers is one of the new confirmed cases.

º The cumulative number of confirmed / probable cases among health workers is 99 (5.9% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Release of a new miraculous baby from Katwa CTE

• A 42-day-old baby was discharged from the Katwa CTE on Saturday, May 11, 2019. Daniella was admitted to the CTE with her mother on April 11, 2019 when she was only 12 days old. Her mother, who arrived in a state of advanced coma, died at CTE the next day. Daniella was collected on April 12 and was positive. After 30 days of treatment with mAb 114, Daniella was cured. She survived thanks to the work of the health staff and the nannies who took turns at her bedside 24 hours a day but also because she was taken care of as soon as she became ill. Nannies are men and women cured of Ebola, and therefore immune to the virus, who care for sick children and babies during their hospitalization.

Medical management in Butembo and Katwa

• Since the departure of Médecins Sans Frontières (MSF) from the health zones of Butembo and Katwa following the deterioration of the security situation last February, the management of the two Ebola Treatment Centers (ETCs) in the city of Butembo has been taken over by the Ministry of Health in partnership with the World Health Organization (WHO) and UNICEF since March 2019.

• Since this transfer of management, many changes have been made to the medical care of patients suffering from Ebola. These changes include:

1. Increased number of health providers in CTEs. The new managers continued to work with MSF-trained caregivers, but they also recruited more care providers to ensure better individual follow-up for each patient. Moreover, from now on, the whole of the medical staff is Congolese and has been recruited locally.

2. Improvement of the nutritional care of the patients which increases their chance of survival.

3. Creation of a team exclusively responsible for admissions to reduce the waiting time for admission.

4. Involvement of the family from the beginning of the treatment of patients with the support of psychologists.

• Two months after this transfer of management, it was important to conduct an analysis to assess the quality of medical care for Ebola patients. The main conclusions of this analysis are:

1. The average duration of hospitalization in CTEs has been reduced, allowing more patients to be treated for the same duration. At Butembo CTE, the average duration of hospitalization increased from 9 to 4 days. And at the Katwa CTE, the average length of stay was 7 to 5 days.

2. There was a reduction in the intra-CTE lethality rate and an increase in the survival rate. Without taking into account those who died less than 48 hours after admission to the CTE, the case-fatality rate for confirmed patients fell from 43.4% to 31.1% in the Butembo CTE and from 43.2% to 33.8%. % at Katwa CTE. As a corollary, Butembo's CTE survival rate increased from 56.6% to 68.9%. At the Katwa CTE, the survival rate increased from 56.8% to 66.2%.

• These data come from the patient database compiled by the Ministry of Health and partners involved in medical care. These data are encouraging as they prove that local health workers are now able to properly care for Ebola patients. It is a great success to congratulate and encourage.

Decentralized operational approach

• The Ministry of Health invited MSF to present their "decentralized operational approach" project at a strategic meeting in Kinshasa this Thursday, May 9, 2019. In summary, the MSF project is structured around three axes:

º OPTION 1 : If the patients accept it, they will be treated in the CTE which remain the reference places for the management of confirmed Ebola patients and who guarantee the best survival rate.

º OPTION 2 : If patients do not wish to visit an ETC, they may go to a local health center or hospital that is prepared to accommodate them.

º OPTION 3 : If patients do not wish to visit a CTE or a health center, they could be cared for at home with the support of the patient and the family with training in transmission reduction with equipment individual protection 'light' and in symptomatic treatment with supervision (if possible).

• Many questions, suggestions and concerns were shared by the Ministry of Health and the technical and financial partners present at this meeting. These questions include:

º How to ensure team safety in such a decentralized approach?

º How to ensure strict compliance with prevention measures at the community health centers and at home?

º What to answer to patients who would like to be cared for in traditional healer centers that are very popular?

º How will families manage contaminated biological fluids for home treatment?

º Can daily support for health centers or families be done remotely when response teams are unable to move about the city due to a security incident?

• MSF was also asked to draw lessons learned from Beni and Mangina where the decentralized approach in the hospitals was used early in the response, prior to the construction of the CTEs. In both areas, this decentralized approach has led to a high rate of nosocomial infections and a high level of contamination among health care workers. A workshop will be organized in the coming weeks with the actors in the field to evaluate the relevance, the feasibility and the acceptability of this approach. Community dialogues will also be organized to involve communities in the choice of response strategies to use.

Security situation

Nothing to report.

FIGURES OF THE RESPONSE

114,067 People vaccinated

• 400 people vaccinated on 11/05/2019.

• Of those vaccinated, 30,648 are high-risk contacts (CHR), 54,994 are contact contacts (CC), and 28,425 are front-line providers (PPL).

• Persons vaccinated by health zone: 30,701 in Katwa, 23,918 in Beni, 13,896 in Butembo, 7,730 in Mabalako, 5,784 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,928 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,472 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Saturday, May 11, 2019

The epidemiological situation of the Ebola Virus Disease dated May 10, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,662, of which 1,574 confirmed and 88 probable. In total, there were 1,112 deaths (1,024 confirmed and 88 probable) and 446 people healed.

• 325 suspected cases under investigation;

• 13 new confirmed cases, including 5 in Butembo, 2 in Kalunguta, 2 in Mandima, 1 in Musienene, 1 in Mabalako, 1 in Katwa and 1 in Masereka;

• 7 new confirmed case deaths, including

º 6 community deaths, including 3 in Butembo, 2 in Kalunguta and 1 in Katwa;

º 1 death at the CTE of Mabalako;

• 2 new cures out of ETCs, including 1 in Butembo and 1 in Beni;

• 1 non-vaccinated Butembo health worker is one of the new confirmed cases.

º The cumulative number of confirmed/probable cases among health workers is 98 (5.9% of all confirmed/probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Visit of the Acting Governor of North Kivu to Butembo

• The Acting Governor of North Kivu, Maître Feller Lutaichirwa, arrived in Butembo on Friday, May 10, 2019 with an inter-institutional delegation composed of the Provincial Security Committee and members of the North Kivu Provincial Assembly to conduct an assessment mission. of the security situation.

• They began their visit with a hearing with the Ebola response coordinators on Friday. This Saturday, May 11, 2019, a social dialogue was organized between the provincial authorities and the representatives of the different social strata of the city of Butembo in the meeting hall of the town hall. Discussions focused on security and health issues. Several people took the floor, such as the president of the Butembo-Lubero Congolese Business Federation (FEC), the first vice-president of the Civil Society Provincial Coordination of North Kivu and journalists.

• Butembo's response coordinator Dr Justus Nsio took the opportunity to explain the evolution of the epidemic in the city before reminding them of the importance of rapid medical care. The social dialogue closed with a firm commitment from the different sections of the population of Butembo to take ownership of the response and accept the instructions of doctors to fight against Ebola. The Interim Governor announced a high-level meeting in Kinshasa to adopt new security measures in Butembo and surrounding areas.

FIGURES OF THE RESPONSE

113,667 Vaccinated persons

• 550 people vaccinated on 10/05/2019.

• Among the vaccinated persons, 30,484 are high-risk contacts (CHR), 54,771 are contacts of contacts (CC), and 28,412 are first-line providers (PPL).

• Persons vaccinated by health zone: 30,546 in Katwa, 23,888 in Beni, 13,803 in Butembo, 7,614 in Mabalako, 5,778 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,928 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,472 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Thursday 9 May 2019

The epidemiological situation of the Ebola Virus Disease dated 8 May 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,604, of which 1,538 are confirmed and 66 are probable. In total, there were 1,074 deaths (1,008 confirmed and 66 probable) and 442 people healed.

• 264 suspected cases under investigation;

• 4 new confirmed cases, including 3 in Mabalako and 1 in Beni;

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Mabalako and 1 in Beni;

º 2 deaths at CTE Mabalako.

/! \ Paralysis of the activities of the Butembo sub-coordination on Wednesday, May 8, 2019.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Nothing to report

Security situation

• Butembo's sub-coordination teams partially returned to work on Thursday, May 9, 2019. However, some health areas in Butembo town remained inaccessible for security reasons.

FIGURES OF THE RESPONSE

112,762 vaccinated persons

• 277 people vaccinated on the 08/05/2019.

• Of the 112,762 people vaccinated, 30,123 are high-risk contacts (CHR), 54,260 are contacts of contacts (CC), and 28,739 are front-line providers (PPL).

• Persons vaccinated by health zone: 30,432 in Katwa, 23,789 in Beni, 13,803 in Butembo, 7,322 in Mabalako, 5,487 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,879 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,487 to Bunia, 1,412 to Lubero, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Health control checkpoints

56,294,541 people under control

• 80 entry points (PoE) and operational health checkpoints (PoC).

• 239,339 travelers went to checkpoints and entry points on 08/05/2019.

• 888 refused sanitary control (0.4%).

Infected healthcare workers

97

• The cumulative number of confirmed/probable cases among health workers is 97 (6% of all confirmed/probable cases), including 34 deaths.

The epidemiological situation of the Ebola Virus Disease dated May 7, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,600, of which 1,534 are confirmed and 66 are probable. In total, there were 1,069 deaths (1,003 confirmed and 66 probable) and 442 people healed.

• 267 suspected cases under investigation;

• 15 new confirmed cases, including 5 in Katwa, 4 in Kalunguta, 4 in Mabalako, 1 in Mandima and 1 in Musienene;

• 14 new confirmed case deaths, including

º 10 community / hospital deaths including 4 in Kalunguta, 4 in Mabalako, 1 in Katwa and 1 in Musienene;

º 4 CTE / CT deaths, 2 in Mabalako, 1 in Katwa and 1 in Butembo;

• 1 new healed patient from Mabalako CTE;

• Two Katwa health workers, including one vaccinated, are among the new confirmed cases.

º The cumulative number of confirmed / probable cases among health workers is 97 (6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

News of the response

Security situation

Armed men launched several attacks in the town of Butembo on Wednesday, May 8, 2019 around 5:30 am. The attackers were repulsed by the Armed Forces of the Democratic Republic of Congo (FARDC). A dozen attackers were killed and six were captured. A policeman from the city also died in the attack. Because of this new security incident, the response teams have limited their movements in the city. Only a minimum service was performed. Since the beginning of May, this is the fifth consecutive day in which the response teams have not been able to carry out all the necessary response activities in Butembo, such as active case finding in the community, vaccination and dignified and secure burials.

• The triage of the Masiki Health Center in Katwa Health Zone was set on fire on Tuesday, May 7, 2019.

• A dignified and secure burial team officer was murdered in Vuhovi on the night of May 7 to 8, 2019. It was in this health zone that the nurse in charge of the Isonga health area had been kidnapped and killed in February 2019.

Vaccination

• Since the beginning of the vaccination August 8, 2018, 112 485 p eople have been vaccinated , of which, 30,432 in Katwa, 23,752 in Beni, 13 803 in Butembo, 7202 at Mabalako, 5407 at Mandima 3608 to Kalunguta, 3070 in Goma, 2879 to Komanda, 2569 at Oicha, 1980 in Kayna, 1930 to Masereka, 1915 at Vuhovi, 1748 at Kyondo, 1487 in Bunia, 1372 in Lubero, 1357 at Karisimbi, 1197 at Musienene, 1025 at Biena, 1012 at Mutwanga, 690 in Rutshuru, 557 Rwampara (Ituri), 527 to Nyankunde 496 to Mangurujipa, 420 Mambasa 355 for Tchomia 342 to Kirotshe, 333 to Lolwa, 254 to Alimbongo, 250 to Mweso, 245 to Kibirizi 161 to Nyiragongo 97 Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

The escalation of Ebola virus disease (EVD) transmission in the North Kivu and Ituri provinces of the Democratic Republic of the Congo continued this past week, with a total of 106 new confirmed cases reported.

The majority of these cases originated primarily from hotspot areas within Katwa, Mandima, Butembo, Musienene, Beni, and Mabalako health zones.

In the 21 days between 15 April – 5 May 2019, 76 health areas within 14 health zones reported new cases, representing 47% of the 163 health areas affected to date (Table 1 and Figure 2). During this period, a total of 298 confirmed cases were reported, the majority of which were from the health zones of Katwa (40%, n=120), Mandima (13%, n=40), Butembo (13%, n=38), Musienene (8%, n=25), Mabalako (8%, n=24), and Beni (6%, n=19).

As of 5 May 2019, a total of 1572 EVD cases, including 1506 confirmed and 66 probable cases, were reported.

A total of 1045 deaths were reported (overall case fatality ratio 66%), including 979 deaths among confirmed cases. Of the 1572 confirmed and probable cases with known age and sex, 55% (870) were female, and 28% (445) were children aged less than 18 years. The number of healthcare workers affected has risen to 95 (6% of total cases), including 34 deaths.

The past week showed a continued deterioration of the security situation in Butembo city. Response activities were temporarily suspended in Butembo and neighbouring health zones from 4-5 May 2019 following a civil demonstration by members of a local moto-taxi drivers union. Although response operations later resumed following negotiations with community leaders, threats of attacks persisted against some healthcare facilities and healthcare providers. In a separate event, on 3 May 2019, a safe and dignified burial (SDB) team in Katwa was also attacked after conducting a SDB of a confirmed case.

The epidemiological situation of the Ebola Virus Disease dated May 5, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,572, of which 1,506 are confirmed and 66 are probable. In total, there were 1,045 deaths (979 confirmed and 66 probable) and 439 people healed.

• 193 suspected cases under investigation;

• 18 new confirmed cases, including 7 in Mandima, 4 in Katwa, 2 in Beni, 1 in Mabalako, 1 in Kalunguta, 1 in Oicha, 1 in Butembo and 1 in Masereka;

• 16 new confirmed deaths, including

º 8 community / hospital deaths including 3 in Mandima, 2 in Katwa, 1 in Mabalako, 1 in Kalunguta and 1 in Masereka;

º 8 deaths at CTE / CT, including 3 in Katwa, 2 in Butembo, 2 in Beni and 1 in Mandima;

• 1 new healed from the Butembo CTE;

• 1 health worker in Mandima is one of the new confirmed cases (community deaths).

º This is a hygienist from a health post in Katanga health area who was unvaccinated and not followed because she refused. She died at home.

º The cumulative number of confirmed / probable cases among health workers is 95 (6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

News of the response

Temporary paralysis of Butembo's response activities

• Response activities slowed down in Butembo town and nearby health areas on Sunday, May 5 and Monday, May 6, 2019. Local response committees located in different parts of the city provided minimal service.

• An increase in the number of cases and deaths is expected in the coming days following this slowdown in response activities to limit the spread of the virus in the community.

Vaccination

• Since the start of vaccination on 8 August 2018, 111,920 people have been vaccinated , including 30,432 in Katwa, 23,551 in Beni, 13,803 in Butembo, 7,332 in Mabalako, 5,133 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,879 in Komanda, 2,569 at Oicha, 1,970 at Kayna, 1,930 at Masereka, 1,915 at Vuhovi, 1,748 at Kyondo, 1,487 at Bunia, 1,372 at Lubero, 1,357 at Karisimbi, 1,197 at Musienene, 1,025 at Biena, 1,012 at Mutwanga, 690 at Rutshuru, 557 in Rwampara (Ituri), 527 in Nyankunde, 496 in Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.